DM FSBS Guideline

Mom is 82, a diabetic, and her sugars often drop below 100 and she feels lightheaded. She’s been told that she should keep her sugars between 70 and 120 but we’ve noticed she often feels better if they are higher. What is a good range of finger-stick sugars for her?

The guidelines for blood sugar control in seniors have changed recently. The Choosing Wisely Campaign from the AGS [American Geriatrics Society] I referenced in previous articles, now recommends that lower sugars are not good for seniors (as contrasted with younger adults, where tighter control is better).

The new advice is: Avoid using medications to achieve hemoglobin A1c less than 7.5% in most adults age 65 and older; moderate control is generally better.

What is the ‘A1c’? The ‘A1c’ is a protein—the hemoglobin A1c—produced in your blood in response to the level of sugar. As the sugar increases, the A1c rises, and reflects the average sugar over the preceding three months. Diabetics should have their A1c measured every 3-6 months. An A1c of 7% indicates an average blood sugar of 154; 7.5% means it’s been 168; 8.0%, it’s 182; for 9.0%, it’s 211.

The AGS found no evidence that tight control in older adults with type 2 diabetes is beneficial. ‘Tight control’ means an A1c less than 7% which usually translates into finger-stick sugars under 100 before breakfast and under 200 the rest of the day.

Compared with ‘looser control’, tight control in seniors results in more harm: higher death rates, and particularly higher rates of hypoglycemia—blood sugars that are too low, meaning less than 70-80, which increases the risk of dizziness, falling, injury, and generally just not feeling as well.

Since it takes years for the benefits of ‘tight control’ to really be seen, the AGS recommends that blood sugar targets should reflect patient goals, health status, and life expectancy. Reasonable A1c targets would be 7.0 – 7.5% in healthy older adults with long life expectancy (meaning more than 10 years), 7.5 – 8.0% in those who have several health problems and a life expectancy less than 10 years, and 8.0 – 9.0% in those with more severe problems and life expectancy less than 5 years.

Furthermore, there’s no evidence that daily blood sugar tests at home benefit seniors if they are not on insulin. They can minimize painful, sensitive fingers by only checking the sugar if they are sick, change medications, are on steroids, or have symptoms suggesting hypoglycemia.

So, use the A1c to help live more comfortably and guide decision-making.